speech & language therapy in practice, autumn 2000
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AUTUMN 2000
GroupsAdapting theenvironment
Sensory
integrationGetting in synch
HomeprogrammesReducing risk
In My ExperienceValuing voice
ISSN 1368-2105
R E F L E C T I V E L E A R N I N G
http://www.speechmag.com
Student traininga uniquepartnership
How I manageearly feeding difficulties
My Top ResourcesIn the community
Two greatreader offers
Photo from: www.johnbirdsall.co.uk
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http://www.speechmag.com
In 1999, Professor Sally Byng spoke to
speech and language therapists from all
over Scotland about her vision of aphasia
services. A year on she was back with
Carole Pound to hear first-hand the
changes that have been made.Annette
Cameron reports.
SIGNALONG researcher Kay Meinertzhagen
recently spoke to a group of learning
disabled adults as part of a project to
establish signing vocabulary for self-
advocacy. What they told her has
implications for the project and for service
providers generally.
The Autumn2000 speechmag web-
site includes:
www.speechmag.com
Also on the site - contents of back issues and news about the next one, links to other sites ofpractical value and information about writing for the magazine. Pay us a visit soon.
Now available: subscribe or renew online!
Reprinted articles
Student teachers recognise their voice needs (Roz
Comins, 2 (4), August 1993)**
At last...stammerers get the right prescription from
their GPs (Lena Rustin and Elaine Kelman, 4 (1),
Nov/Dec 1994)**
A service resource - New ventures in group
placements for students. Part 2 - Group placements
with adults with a learning disability (Ann Parker
and Rachel Farazmand, Winter 1997)***
From Speech Therapy in Practice* / Human Communication**,courtesy of Hexagon Publishing, or from Speech & LanguageTherapy in Practice***
tel: 01561 377415 www.speechmag.com
reflective. creative. hardworking.original. energetic. friendly.approachable. thoughtful.interesting. realistic. up-to-date.reliable. the magazine thats you.
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20 Home programmes...when parents understand more fully the nature of
their childs stammering and their role in its
remediation, they are often very resourceful inmaking arrangements so they can attend therapy.
However, for a minority, there may be reasons...which
mean regular attendance is impossible.
Sharon Millard, Frances Cook and Jane Fry
explain how a new approach is benefiting children at
risk of persistent stammering who are unable to
attend a clinic for therapy.
24 Further ReadingEarly intervention, hearing impairment,
dysarthria, AAC, dementia.
25 How I manageearly feedingdifficultiesFeeding management should always be
seen as multidisciplinary. This is sometimes
difficult to put into practice in community
caseloads but, the more we consult our
colleagues such as dietitians and
psychologists for advice, the more we gain
professionally - as do they.
There are many questions about the speech
and language therapists role with early
feeding difficulties. Sue Strudwick,
Joanne Marks and Sara Russell provide some ofthe answers.
30 My Top ResourcesRecent groups have been either language disability-
focused or project-based;
for example people with
aphasia produced a leaflet
for others with aphasia.
For the near future we are
hoping the service will be
able to replicate a model
of effective group
intervention via
conversational analysis.
Linda Armstrong and
Alison Parsons have to
adapt their working practice
to take account of the
geographical spread of their
clients - adults with acquired
neurological problems.
SUMMER 2000(publication date 28th August)
ISSN 1368-2105
Published by:Avril Nicoll33 Kinnear SquareLaurencekirkAB30 1ULTel/fax 01561 377415e-mail:[email protected]
Production:Fiona ReidFiona Reid DesignStraitbraes FarmSt. CyrusMontrose
Printing:Manor Creative Print LtdUnit 7, Edison RoadHighfield Industrial EstateHampden ParkEastbourneEast Sussex BN23 6PT
Editor:Avril Nicoll RegMRCSLT
Subscriptions and advertising:Tel / fax 01561 377415
Avril Nicoll 2000Contents of Speech & LanguageTherapy in Practice reflect the viewsof the individual authors and notnecessarily the views of the publish-er. Publication of advertisements isnot an endorsement of the adver-tiser or product or service offered.
Any contributions may also appearon the magazines Internet site.
2 News / Comment
4 GroupsAs therapists, we were reminded how little wenormally adapt our usual working practice, as we are
often unaware that our clients have particular
sensory impairments... We found small changes made
a big difference when enabling clients to achieve
success.
Christine Griffiths and Alison Gedling investigate
the efficacy of speech and language therapy for
people with learning disability and sensory
impairment attending a Day
Centre.
8 Sensory
integrationSpeech and language therapy
assessment and intervention
techniques with, for example,
children with speech disorders,
have the potential to be
informed and transformed by
sensory integrative theory and
practice.
Olwen Pate reveals how
getting suck, swallow, breathe
in synch can facilitate progress
in oral motor skills and speech.
11 Reader OffersWin CELF and Speech Sounds on Cue
12 ReviewsAdult neurology, syndromes,
dysfluency, progressive
neurological, language
development, education,
articulation, autistic spectrum,
child development.
18 In my
experienceThe cry of a teacher in vocal
distress should not fall upon deaf
ears; rather we should seek to
ensure it is never raised at all.
Caroline Cornish on the case for
a national policy of preventative
voice care for student teachers.
ContentsAUTUMN 2000
Cover picture:See page 14, Competence, confidenceand commitment.Photo from: www.johnbirdsall.co.uk
www.speechmag.com
IN FUTURE ISSUES
FRAGILE X PROGRESSIVE NEUROLOGICAL DISORDERS DOWN SYNDROME
PHONOLOGICAL AWARENESS DYSPHAGIA TRAINING
TrainingWe have been moving towards
emphasising reflective cycles of learning
which integrate practice, theory and
rehearsal, rather than the traditional
linear model with its expectation thattheory and observation should always
precede practice.
Suzanne Beeke and Ann Parker are
behind an innovative programme
where speech and language therapy
students become temporary volunteers
for the Stroke Association.
14 COVER STORY
Please note our new address!
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Inclusion and autism
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 20002
news
People with aphasia
are being encouraged
to demand an ade-
quate service.
Members of the
charity Speakability
have developed a
Charter for People
with Aphasia
based on their
own experiences
and reflecting
clinical guide-lines endorsed
by the
Department
of Health. It
includes a list
of speech
and lan-
guage ther-
apy rights.
A recent
survey by
Speakability draws attention
to the paucity of aphasia services and the drain
dysphagia care places on resources.
Helpline Freephone 080 8808 9572 Mon-Fri 10am-4pm
Speakability, tel. 020 7261 9572.
A new report slams the quantity, organisation and targeting of care and treatment
for people with disabilities.
As a result of the reports findings, the Royal College of Physicians has produced a
set of recommendations for commissioners of healthcare, NHS managers, medical
educators and doctors aimed at redressing the balance towards the needs of dis-
abled people. Specifically, they want to see the specialty of rehabilitation medicine
developed, adequate staffing levels and a change in medical attitudes so doctors pro-
mote disabled peoples abilities and empower them to participate in society.
However, a British Society of Rehabilitation Medicine survey of NHS resources sug-
gests there is a long way to go to meet the recommendations. The tenfold or greater
differences in access of disabled people to NHS consultants in rehabilitation theyidentify lends support to the theory of rationing by postcode, and they call for
inequities to be addressed urgently.
Medical rehabilitation for people with physical and complex disabilities, RCP,
www.rcplondon.ac.uk
BSRM, tel. 01992 638865.
The charity Scope has welcomed an Audit Commission report highlighting waste and
failure within NHS disability services, and urged an immediate crackdown.
However, Scope says the government should have introduced national standards
years ago and is disappointed that the report still fails to emphasise the need for NHS
providers to listen to disabled people. Its campaigns officer says, If the providers of
such services had a duty to take on board the views of equipment users, there would
be far less waste and inefficiency. For disabled people to achieve equality and inte-
grate into mainstream society, the government has to ensure that the right equip-
ment gets to the right people right now.
Fully Equipped (28/3/00) from the Audit Commission.
Scope, tel. 020 7619 7100, www.scope.org.uk
Children with autism and Asperger
Syndrome are on average twenty
times more likely to be excluded
from school than their peers.
According to a report commissioned
by the National Autistic Society, the
situation is even worse for more ablechildren with autism, of whom 29 per
cent have been excluded from school
at one time or another. The Society is
calling for urgent action to address
the lack of expertise, time and spe-
cialist help thought to lie at the root
of the problem. Its education adviser
points out that Parents of children
in autism-specific units and schools -
where exclusions rarely arise - are
twice as likely to be satisfied with
provision than those whose children
attend mainstream or special educa-
tion needs schools.
The report also finds there is less
awareness by the time a child reach-
es secondary age and that exclusioncontinues into adulthood. Although
many adults cited a job as one of the
most important issues for their
future fulfilment, only two per cent
of adults with autism, including
graduates, are in full-time paid work.
Inclusion and Autism: Is it Working?
From the National Autistic Society,
393 City Road, London EC1V 1NG,
www.oneworld.org/autism_uk
Disability servicesslammed
Dementia visionPeople around the country are being asked for their views and experiences
of services and their vision of dementia care.
Alzheimer Scotland - Action on Dementia is working on a major project to
create a Scottish Dementia Care Services Template. At its core will be targets
for the range and volume of services which should be available to people
with dementia and their carers from the start of the illness to the final stages.
Essential services listed include memory clinics and rehabilitation / therapies.
Contact: Public Policy Department, Alzheimer Scotland - Action onDementia, 22 Drumsheugh Gardens, Edinburgh EH3 7RN.
Dementia Helpine (Scotland), freephone 0808 808 3000.
Partnership between carers, people with dementia and the research community
is also the aim of the Alzheimers Society which is recruiting people
for an advisory network to inform its research programme,
Quality Research in Dementia. Focusing on cause, cure and
care projects, 1 million per year has been com-
mitted, the largest investment by any
charity into dementia-related research.
Alzheimers Helpline: 0834 300 0336.
S.M.A.R.T. movesAn assessment to prevent misdiagnosis of vegetative state in patients with pro-
found brain injury will be available to rehabilitation units by the end of the year.
The Sensory Modality Assessment and Rehabilitation Technique (S.M.A.R.T.)
has been developed over a ten year period by occupational therapy staff at
the Royal Hospital for Neuro-disability. The hospitals brain injury unit treats
the largest concentration of patients in a vegetative state in the UK. Using
S.M.A.R.T., one study of patients admitted with a referring diagnosis of veg-
etative state found 43 per cent had been wrongly diagnosed. Such misdiag-
nosis can lead to a patient with the potential ability to communicate their
needs - such as someone with locked-in syndrome - spending the rest of their
life trapped in a damaged body. Vegetative state is the most profound form
of brain damage where the person is awake but completely unaware of
what is happening around them or within their own body.
The assessment provides a structured sensory programme which assesses the
five senses, movement, communication and wakefulness. The multidiscipli-
nary team and the patients relatives and friends are a key part of this
process.
www.neuro-disability.org.uk
Aphasiacharter
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National screeningA programme to screen for deafness in new-born
babies is to be phased in from September this year
before being rolled out nationally.
The Royal National Institute for Deaf People has wel-
comed this development, saying The test can be
carried out within 48 hours of birth and does not dis-
turb the baby. It involves an instrument sending a
sound into the babys ear and measuring the level ofreturned sound which calculates the level of hearing
function. The test is proven to be cost effective and
reliable. The organisation believes a comprehen-
sive national screening programme will enable earli-
er provision of aids, introduction to sign language
and development of communication. Health visitor
distraction tests used currently have a poor record in
identifying children who are born deaf.
RNID, tel. 020 7296 8000, www.rnid.org.uk
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 3
news & comment
Jane Austen knewIn a scene in Pride and Prejudice, Elizabeth Bennet observes that Mr Darcy
must comprehend a great deal in his idea of accomplished if he knows only
six such women. He and Caroline Bingley list the numerous qualities and skills
they consider necessary and Lizzy is forced to conclude I am no longer
surprised at your knowing onlysix accomplished women. I rather wonder
now at your knowing any.
What makes an accomplished speech and language therapist? A number ofclues come from Sue Strudwick. A therapist must be knowledgeable,
competent, empathetic, enthusiastic, honest and realistic, as this builds a
client or carers trust and confidence and contains their anxieties. How I
manage early feeding difficulties demonstrates this is enhanced when our
goals are patient-led, when we work with other professionals as a team and
when the organisation of our posts allows us to cross boundaries to provide
the consistency clients need.
Like teachers, our voice is the tool of our trade, but do we appreciate the
potential we all have to improve it? Caroline Cornish believes we should be
committed to development of the voice to make it the source of real
inspiration to others.
Initiative and flexibility are needed to carry out speech and language therapy
in challenging environments. For Linda Armstrong andAlison Parsons this
means some rather unusual top resources, as they work in a large rural area
where their adult clients are spread out and not easy to reach.
We need to remember to apply what we know. Christine Griffiths andAlison
Gedling refer back to their own guidelines as a reminder of small
environmental changes that can make all the difference to a client with
learning disability and sensory impairment.
We have to be responsive. Sharon Millard, Frances CookandJane Fry
understand that attendance at a clinic is not always possible and use other
methods - such as telephone contact - to ensure timely therapy can still be
provided to those who are motivated.
However, as Olwen Pate has found, the key to success is in the integration of
skills, and the challenge for us is how to facilitate this not only in our clients
but in ourselves. Suzanne Beeke andAnn Parkergive us an example with
their innovative programme of student training based on reflective cycles of
learning which integrate practice, theory and rehearsal through active
participation.
As Jane Austen knew, we can pick out individual qualities and skills that are
important - but that wont tell you what distinguishes the Elizabeth Bennet
from the Caroline Bingley.
...comment...
Avril Nicoll,
Editor
33 Kinnear Square
Laurencekirk
AB30 1UL
tel/ansa/fax 01561
377415
e-mail
Online consultationA website is providing a groundbreaking method of
responding to a public consultation exercise.
Visitors to the Disability Rights Commission site can
respond online to a joint consultation with the
Department for Education and Employment on a
new draft Code of Practice for making goods and ser-
vices more accessible to disabled people. The draft
Code is posted on the website, along with a responsedocument which can be filled in and returned online.
The site meets high standards for accessibility and has
approval from the Royal National Institute for the Blind.
DRC, tel. 020 7211 3000, www.drc-gb.org
Education trainingThe national educational charity for children with
speech and language difficulties has extended and
developed the training it offers.
In addition to extra courses focusing on integrating
speech and language targets and approaches into the
classroom and curriculum, a series of seminars present-
ed by internationally regarded experts will provide an
up-to-date review of a range of topics. If distance is a
problem, workplace training encourages authorities to
purchase I CANs multidisciplinary training at a local
venue - significantly reducing the cost per person.
Details: Jaszia Lindon, Training Administrator, 0870
010 7088.
New chiefs plansThe new chief executive of the charity which helps
families who care for children with a disability orspecial need brings extensive experience in the par-
liamentary and public affairs field to her role.
Francine Bates plans include the expansion of advice
and information services to parents and professionals.
She is also particularly looking forward to the imple-
mentation of legislation which brings forward new
entitlements for carers of disabled children in the field
of social care and special needs education. On the
health front, we are working closely with NHS Direct
Online and will be launching our new directory of spe-
cific conditions and rare syndromes in January 2001.
Contact a Family, tel. 020 7383 3555,
www.cafamily.org.uk
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groups
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 20004
e have been carrying out a
research project looking at
the efficacy of speech and
language therapy with peo-
ple with learning disability
and sensory impairment
(Griffiths and Gedling, 1999). Research suggests
the incidence of visual and hearing problems in
people with learning disability is high, particularly
those with Downs syndrome (Yeates, 1989; Kwok
et al, 1996; van Schrojenstein Lantman-de Valk et
al, 1994). A large study of 45,000 adults indicates
a prevalence of sensory impairment among adults
with intellectual disability comparable to orgreater than that found in the general population
and that these sensory deficits occur with increas-
ing frequency with advancing age (Janicki and
Dalton, 1998). Research also indicates that carers
are not reliable in identifying these deficits (Haire
et al, 1991) and that there is a need to heighten
awareness among staff and other carers with
regard to vision and hearing problems and the
consequent problems which may develop in inter-
personal communication and adaptive function-
ing. Aitken and Buultjens (1992) also point out
the effects on communication, including pragmat-
ics and non-verbal communication, and many
studies further recognise the changes in behav-
iour that can occur (Stafron, 1995; Castane and
Peris, 1993).
Part of our work is with people with learning
disability who attend a Day Centre. We felt the
focus of our intervention should be social com-
munication skills and targeted three common
areas we deemed feasible to work on with people
with a wide range of learning disability:
1. eye contact
2. initiation
3. turn-taking.
In our planning we considered the above research
findings: the high incidence of hearing / visual
difficulties, the effects of ageing, the need to
raise staff awareness, and the effects of sensory
W
A (sight and)sound
foundation
We may be aware of the
effects of visual and
hearing impairments on
communication, but how
often do we routinely allow
for them when planning
therapy? Christine Griffiths
andAlison Gedling tell us
how small changes made a
big difference to their clients
with a learning disability.
Read this if you:
work with any client with
sensory impairment
offer staff training
want social skills therapy
ideas
impairment on communication and behaviour.
All the clients had their vision and hearing
assessed at the Day Centre prior to communication
assessment and intervention. Results, including a
breakdown of degree of impairment, are in tables
1-3 (page 6). This information was then taken into
consideration when carrying out the intervention
programme, particularly in terms of positioning,
size of materials and environmental factors.
Guidelines were also written for staff (figure 1).
Small stepsClients were assessed using the Background infor-
mation and Social Communication skills sectionsof the Personal Communication Plan for People
with Learning Disability (PCP) (Hitchings and
Spence, 1991). We felt, however, that any poten-
tial progress in the people with more severe/pro-
found learning disability may not be identified
from the PCP rating scale, as it is not broken down
into small enough steps. We therefore decided to
include video of client/carer interactions. These
were then analysed by:
Using observation checklists and momentary
sampling to identify the individuals levels of
engagement (Bunning, 1991).
Identifying particular aspects within each level of
engagement, such as awareness, initiation and rec-
iprocation. These could then be matched against
appropriate sections of the PCP - eye contact, open-
ing a conversation (initiation) and turn-taking.
The focus of intervention was the same for all
the clients who received treatment: eye contact,
initiation and turn-taking. However, we felt it
was appropriate to develop two programmes to
respond to the cognitive level of those involved.
In practice we found that, whilst one distinct pro-
gramme was better for one person, another
might benefit from a mixture of the two, and so
the programmes were meant to be flexible in this
respect. The intervention was offered as a regular
weekly session over a ten-week period (figures 2
and 3).
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groups
Figure 1 - CommunicationGuidelines
8 rules when speaking topeople who have visionand / or hearing loss
1. Make sure you have thepersons attention first.
2. Make sure thatdistractions are kept to aminimum.
3. Prepare the environment.
4. Make sure there isappropriate lighting.
5. Look directly at thelistener and dont turnaway while talking.
6. Make sure that your faceand mouth are not hidden.
7. Value the persons
communication.
8. Adapt yourcommunication to enablethe person tocommunicate better.
Figure 2 Treatment plan (Profound group)
Each week - develop a routine. Begin the session with an object of reference (for example a bean bag) and music.Finish with music and put all items away together.
Weeks 1 to 3 - eye-contact
The aim of these three weeks was to attract the clients attention and maintain it. Activities included the use of avariety of glittery objects and a torch (or auditory objects), the task increasing in complexity as follows:1) Say the clients name.
2) Hold the object in front of their line of vision. Use a torch to refract the light.3) When they have focused on it, move it towards your eyes.4) When achieved say Hello.The session finished by building a tower of blocks. The client was encouraged to look at each block (held near thespeech and language therapists face).
Weeks 4 to 6 - turn-taking
These sessions encouraged the client first to copy actions and then to take turns in a variety of activities; for exam-ple taking an object out of a feely bag and doing an action with it, using peg-boards, jigsaws, colouring paper sil-houettes on black card, using bubbles.The session finished by taking turns to build the tower of blocks.
Weeks 7 to 9 - initiation
These sessions encouraged the client to make a choice between three musical instruments and imitate an action.The instruments were then put out of reach, the client having to use physical contact - such as a tap on the arm orvocalisation - to be given one of them. This was initially facilitated. Other activities included selectingcrayons/chalks, different coloured paper for contrasts and chalkboards.The session finished by encouraging the client to use eye contact, vocalisation, reaching or tapping our arm toattract our attention to get a block for building the tower.
Week 10 - eye-contact, turn-taking and initiation
Clients were encouraged to participate in cake decorating using a variety of toppings and icing pens.
Figure 3 Treatment Plan (Mild/moderate/severe group)
Weeks 1 to 3 - eye contact
Activities included:1) Ball games and signing/saying each others names, what you like to eat, and so on.2) Dressing-up items - hats, glasses, red noses, masks. Look in the mirror and at eachother.3) Describe yourself. (Talkabout)4) Happy/sad masks - choose the mask that is the same as me.
5) Describe family members - colour of hair etc.6) Make up faces with Magnetic Way To Language (now Magnetic Storyboard)7) Cut out eyes, ears, noses etc. from various materials and make up faces on paperplates.8) Eye pointing to particular pictures.
Weeks 4 to 6 - turn-taking
Activities included:1) Copy rhythms on a tambourine or drum.2) Select an item from a feely bag and do an action with it. Copy each other.3) Take turns to trace around place setting shapes and colour them in.4) Take turns with jigsaws, peg-board patterns etc.5) Whats my mime?game - guess the animal being mimed.6) Pelmanism.
Weeks 7 to 9 - initiation
Activities included:1) Using greetings and responses.2) Choice of musical instrument - client encouraged to initiate the rhythm for us tocopy.3) Feely bag - initiate action with item pulled out.4) Client to finish the last bit of a task; for example, the last piece of jigsaw, place set-ting (no fork), drum and stick. Attract our attention to do this.5) Model food - select what you like to eat.6) Decorating a Christmas tree.7) Making paper chains.8) Making gift tags.
Week 10 - eye-contact, turn-taking and initiation
The final week encouraged the client to use eye contact, take turns and initiate con-tact whilst participating in cake decorating. A selection of toppings and icing penswere available and fairy cakes.
Figure 4 Environmental programme for staff
Week Staff programme
1 gaining attention
2 attention and positions
3 contrasts and zones
4 reduce distractions
5 carer communication
6 carer communication
7 carer communication
8 environmental
9 environmental
10 task for staff to evaluate theeffectiveness of guidelines given
In our planning we considered the high
incidence of hearing / visual difficulties,
the effects of ageing, the need to raise
staff awareness, and the effects of
sensory impairment on communication
and behaviour.
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Staff were also given information every week
advising them of various environmental aspects
that should be considered (figure 4) and sugges-
tions for activities were given. All information
was recorded in an exercise book, which was also
available for staff to note their own comments
along with a pictorial reminder of the guidelines.
FlexibilityWe found this approach very useful when work-
ing with adults with a wide range of learning dis-
abilities and additional sensory impairments. Two
programmes which focused on the same areas of
intervention allowed us the flexibility to adapt
the sessions to the appropriate cognitive ability of
the client. They also gave us a solid structure on
which to build the additional requirements neces-
sary for the particular sensory impairment of that
client. Staff also found it much easier to focus on
themes.
As therapists, we were reminded how little we
normally adapt our usual working practice, as we
are often unaware that our clients have particular
sensory impairments. We may automatically try
to reduce noise levels, too much visual stimulation
on the walls and so on, and position for optimum
communication. However, we rarely routinely
groups
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 20006
consider the effects of glare, contrasts between
our visual material and the table or the effects of
open windows and doors - even though we are
aware of them. It was therefore certainly benefi-
cial to us to look through our own guidelines and
consider these whilst preparing the equipment
beforehand. We found small changes made a big
difference when enabling clients to achieve suc-
cess.
As with any course of intervention ours was not
without problems, which generally were con-
cerned with factors we couldnt change such as
absence of clients and staff, clients health, and
attendance at respite care. We also experienced
some difficulty in disseminating information
amongst staff, which obviously affected the conti-
nuity of care to our clients.
This approach required some forethought, par-
ticularly from staff, and therefore could have
been seen as time-consuming. Whilst there
remain many aspects that will require encourage-
ment to be routinely carried out, changes were
made where possible. There was definitely
heightened awareness regarding the sensory
needs of individual clients amongst staff and
nearly all the clients receiving intervention made
progress. This has given us a sound foundation on
which to build further work on social communica-
tion skills with our clients in Day Centres.
Christine Griffiths is Deputy manager and Alison
Gedling a speech and language therapist for the
Learning Disabilities Directorate, Bro Morgannwg
NHS Trust.
AcknowledgementsOur thanks go to Maggie Woodhouse, Senior Lec-
turer of Optometry and Jonathan Joseph,
Principal Audiologist who carried out the sensoryassessments at the relevant Day Centres and
therefore made this study possible.
ReferencesAitken, S. & Buultjens, H. (1992) Vision for Doing:
Assessing Functional Vision of Learners who are
Multiply Disabled. Moray House Publications,
Edinburgh.
Bunning, K. (1991) Individualised Sensory
Environments: Assessment and Intervention.
Unpublished.
Castane, M. & Peris, E. (1993) Visual problems in
people with severe mental handicap. Journal of
Intellectual Disability Research 37(Pt 5): 469-78.
This approach
required some
forethought,
particularly from
staff
Table 1 Level of learning disability; clients level of vision
Clients level of vision
normal mild normal moderate severe profound uncooperative Totalwith ownglasses
Learning mild 3 1 2 0 0 0 0 6
disability moderate 19 37 11 15 5 0 0 87
severe 4 16 0 10 7 1 11 49
profound 0 3 0 2 1 3 4 13
Total 26 57 13 27 13 4 15 155
Table 3 Clients level of hearing; clients level of vision
Clients level of vision
normal mild normal moderate severe profound uncooperative Totalwith ownglasses
normal 20 40 10 11 8 2 2 93
Clients mild 1 5 0 2 2 0 2 12
level of moderate 2 11 1 7 2 1 4 28
hearing severe 1 0 0 0 0 0 0 1
profound 0 0 1 1 0 0 0 2
uncooperative 0 1 0 5 1 1 7 15
Total 24 57 12 26 13 4 15 151
Table 2 Level of learning disability; clients level of hearing
Clients level of hearing
normal mild moderate severe profound uncooperative Total
Learning mild 5 0 1 0 0 0 6
disability moderate 66 7 11 1 1 1 87
severe 24 5 14 0 1 7 51
profound 2 0 5 0 0 7 14
Total 97 12 31 1 2 15 158
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Griffiths, C. & Gedling, A. (1999) A longitudinal
study to evaluate the efficacy of Speech and
Language Therapy interventions on social com-
munication skills in those individuals with sensory
impairment and learning disabilities.
Unpublished.Haire, A. P., Vernon, S. A. & Rubinstein, M. P.
(1991) Levels of visual impairment in a day centre
for people with a mental handicap. Journal of
the Royal Society of Medicine 84 (9): 542-4.
Hitchings, A. & Spence, R. (1991) The Personal
Communication Plan for People with a Learning
Disability. NFER-Nelson, Windsor.
Janicki, M. P. & Dalton, A. J. (1998) Sensory impair-
ments among older adults with intellectual dis-
ability. Journal of Intellectual and Developmental
Disability23 (1) 3-11.
Kwok, S. K., Ho, P. C., Chan, A. K., Gandhi, S. R. &
Lam, D. S. (1996) Ocular defects in children and
a d o l e s c e n t s
with severe
mental defi-
ciency. Journal
of Intellectual
D i s a b i l i t y
Research 40 (pt
4) 330-5.
Stafron, J.
( 1 9 9 5 )
Unpubl i shed
excerpts from
study day into
dual sensory
impairment -
SENSE.v a n
Schrojenstein
L a n t m a n - d e
Valk, H. M.,
Haveman, M.
J., Maaskant,
M. A., Kessels,
A. G., Urlings,
H. F. &
Sturmans, F.
(1994) The
need for
assessment of
sensory func-
tioning in age-
ing people
with mental
h a n d i c a p .
Journal of
Intellectual Disability Research 38 (pt 3): 289-98.
Yeates, S. (1989) Hearing in people with mental
handicaps: a review of 100 adults. British Institute
of Mental Handicap 17 (March).
ResourcesMagnetic Storyboardfrom Winslow, 59.95.
Talkaboutby Alex Kelly from Winslow, 32.00.
Whats my mime?LDA (discontinued).
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 7
groups
eflections
Do I find out the
extent of a
clients sensory
mpairments and
adapt therapy
accordingly?
Do I consider
how to measure
or smallchanges which
would not be
dentified by
tandardised
assessments?
Do I differentiate
he same task
when planning
herapy to allow
or the different
abilities of group
members?
...RESOURCES...RESOURCES...RESOURCES...RESOURCES.
Everyday Lives, EverydayChoicesThe ways in which the choices of people withsevere learning disabilities can be understood andimplemented are explored in a new book.Themes include communication, work, citizenadvocacy and staff development and training. Itmakes recommendations for government, localand health authorities, service providers and staffresponsible for individual assessment.Everyday Lives, Everyday Choices, 22.50 + p&p,from The Foundation forPeople with LearningDisabilities, tel. 0207535 7441/7455.
Hearing aid choiceA free, independent information pack explains thepotential pitfalls of choosing a hearing aid andgives information on the full range of options.Developed by a national charity with the supportof top hearing aid specialists, the guide is aimed atensuring people make an informed choice andavoid a costly or disappointing mistake.From Defeating Deafness, tel. 020 7833 1733.
MND Resource FileA comprehensive patient and carer-centredguide has been produced to support profes-sionals in achieving quality of life for peoplewith motor neurone disease.Areas covered include nutrition and dyspha-
gia, speech and communication and pallia-tive care. The guide aims to facilitate multi-disciplinary working and provide practicalhelp to professionals facing the challenge ofthe rapid progression of this disease and thecomplex needs of sufferers.Motor neurone disease kills three peopleevery day in the UK. Average life expectancyfrom diagnosis to death is just 14 months.MND Resource File 10 + 2 p+p, tel. 01604
250505, e-mail [email protected] MND Association Helpline, Mon-Fri, 9am-10.30pm, 08457 626262.
Turn your backThe forthcoming European Week for Safety andHealth is themed Turn your back on back pain.An accompanying pack includes posters, stickers,fact sheets, a range of booklets and ideas foraction. Musculoskeletal disorders and back painare the biggest single cause of absence from work.16-22 October, 2000 InfoLine: tel. 08701 545500
Our Mum has ParkinsonsA former schoolteacher has written a book explain-ing Parkinsons to children.Karen Goodall (40) was diagnosed with Parkinsonseight years ago and saw a real need to help otheryounger sufferers in this way. She says, I want chil-dren whose parents have the condition to know thatthere is help available and theres no need to be con-fused, embarrassed or shocked by Parkinsons.One in twenty people with Parkinsons are under
40 at the time of diagnosis.Our Mum has Parkinsons, 1 inc.p&p, tel. 01473212115. Parkinsons Disease Society, tel. 020 7931 8080.
Money Talks!A new educational soft-ware pack provides foursimulations for childrento practise money skills.The activities cover cost
of items on a till, shop-ping and selling, payingbills and money in asafe. Text is also spoken.Money Talks! on CDROM is suitable for 7 - 15 year olds. A single user
pack is 35 + VAT.From Topologika, tel. 01326 377771, www.topol-gka.demon.co.uk
Stroke AssociationThe Stroke Association has revised Learningto Speak Again and replaced it with a 12page booklet, Communication problemsafter stroke. It provides explanation of thecommon difficulties, assessment and treat-ment, and includes practical suggestions.Tel. 01604 623933/4/5/7/8.Stroke Awareness Week, 1-7 October 2000,will focus on the importance of continuingwith medication to lower blood pressure. Aninformation pack is available.Tel. 020 7566 0319 / e-mail Sue Knight on
InspirationA CD ROM to developideas and organisethinking is now avail-able in a UK version.This visual learning soft-ware tool includes facili-ties to create and modi-fy concept maps andwebs and to prioritise and arrange ideas.
A 30 day trial of Inspiration can be down-loaded from www.tagdev.co.uk
Seaside SignalongTwo resources from Signalong aim to help
with planning and enjoying a trip to the sea-side. A manual of 233 signs is accompaniedby an activity pack to help organise the dayand enable people in your care to learn fromtheir experiences.Signalong by the Sea and Activity Pack - tel.Signalong, 01634 819915.
Jobs on the netThe growing market of web-based servicesfor employers and job-seekers includes a sitededicated to health jobs. Templates allowemployers to post vacancies online and appli-cations can also be forwarded in this way.www.healthjobcentre.co.uk
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7/28/2019 Speech & Language Therapy in Practice, Autumn 2000
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sensory integration
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 20008
pproaches to assessing and man-aging oral and speech motor
deficits in children usually include
tasks to evaluate and practise iso-
lated and sequenced oral and
speech motor movements. Such
end-product assessment of motor function sup-
ports the view that oral and speech motor deficits
are evidence of a peripheral motor output diffi-
culty. Intervention that follows this assessment
approach is likely to aim to develop specific out-
put skills to a given level, for example, the ability
to lick lips all the way round, or increasing the
speed and accuracy of /t/ production in isolation.
These techniques, while providing information on
deficits at a motor output level, do not identify
deficits that may be present at an earlier sensory
input level. Sensory input deficits may also cause
and / or contribute to oral and speech motor
deficits.
Sensory integrative theory (from the
Occupational Therapy field) emphasises sensory
inputs/deficits when assessing and developing
motor function. Motor planning and coordina-
tion difficulties are considered to be manifesta-
tions (end-products) of interference in the organ-
isation and processing of tactile, proprioceptive
and vestibular sensations. In sensory integrative
theory, then, an end-product behaviour, such as
developmental dyspraxia, is indicative of underly-
Read this if you work with any client with
a speech disorder find oral motor work
ineffective for improvingspeech
want to learn more aboutsensory integration
Aing sensory difficulties and a sensory integrativedisorder (Ayres, 1979). Sensory integrative theory
and research provides the evidence for practice
using sensory integrative approaches with clients
with sensorimotor difficul-
ties. Speech and language
therapy assessment and
intervention techniques
with, for example, children
with speech disorders,
have the potential to be
informed and transformed
by sensory integrative the-
ory and practice.
Since the control of artic-
ulatory movements for
speech demands the coor-
dination and integration
of multiple structures
(Smith et al, 1995), it is fundamental that assess-
ment and intervention reflect and treat these
structures and their function. The level and
nature of breakdown in planning, coordinating
and integrating oral, pharyngeal, laryngeal and
respiratory function is not likely to be clear when
isolated oral motor skills are assessed. That is,
when we ask a child to touch their nose with their
tongue, we are simply identifying the presence,
absence and, at times, the quality of a particular
movement. It is unclear as to how this movement
When faced with a speech disordered client, therapists often
recommend oral motor activities. While these may produce specific
splinter skills, any generalised benefit - particularly for speech - is
dubious. Olwen Pate explains how an approach using sensory
integrative theory has the potential to transform speech - even before
any work on speech is undertaken.
affects or relates to another, and particularly howit may influence the way in which articulators pro-
duce a target speech sound in an integrated fash-
ion. This is to say nothing of how a sound is then
produced in a word or sequence of words.
Developing isolated oral motor skills may
result in ongoing difficulties with the
integration of sensorimotor information
for the purposes of adapting to changing
oral and speech output demands (Pate &
Pinkstone, 1996).
EssentialEarly oral sensory motor experiences are
essential for developing oral motor plan-
ning skills (Pate & Pinkstone, 1996). They
also enhance the coordination of the
refined movement patterns required to
produce subtle sound changes forming
speech (Laurel & Windeck, 1989). Oetter et al
(1995, p3) have stated that Suck Swallow Breathe
(SSB) Synchrony is the fundamental sensorimotor
pattern and the primary oral motor mechanism.
As such, SSB synchrony is potentially a mechanism
by which skills that affect articulatory control can
be assessed and developed.
Rhythmical, coordinated sucking, swallowing
and breathing - or SSB synchrony - is the first
developmental pattern that requires timing and
sequenced movements (Oetter et al,1995, p3).
Getting
in synchwith suck,swallow, breathe
The level and natureof breakdown inplanning, coordinatingand integrating oral,pharyngeal, laryngealand respiratoryfunction is not likely to
be clear when isolatedoral motor skills areassessed.
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11/32SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 9
sensory integration
Since suck, swallow and breathe are survivalbased, anatomically and functionally related
processes (Wolf & Glass, 1992), they are critical to
many elements of a childs development. Oetter
et al (1995) state that without the presence of
intact, underlying neuro-motor physiology (for
example, SSB; postural control) the development
of sound production and language may by dis-
rupted or disordered. In agreement, Selley et al
(1990, p326), when identifying factors common to
feeding and speech production (for
example, rhythm; oral and respirato-
ry control) have stated that a nor-
mally co-ordinated feeding mecha-
nism is an essential milestone in nor-
mal development, both for more
mature swallowing and for speech.
Pinkstone (1995), in a single case
study, hypothesised that SSB syn-
chrony is fundamental to competen-
cy in and the development of oral
sensorimotor and speech production
skills. A subject with developmental
verbal dyspraxia was provided with
increasingly complex oral sensori-
motor play experiences to facilitate SSB syn-
chrony. Statistically significant changes in the
subjects oral motor output resulted. Sound sys-
tem developments also occurred. Both develop-
ments were achieved without working directly on
oral motor or speech production skills. The inter-vention used was based on the M.O.R.E. tech-
nique, developed by Oetter et al (1995).
ComplexityThe M.O.R.E. technique provides a method for
assessing and developing suck swallow breathe
synchrony. This technique classifies oral play
materials in terms of the complexity of Motor (M),
Oral (O), Respiratory (R) and Eye/hand (E) involve-
ment. The oral and respiratory com-
ponents of the technique are most
important for clinicians working
with speech disordered children.
Each element of M.O.R.E. can be
graded in terms of 4 grades of diffi-
culty, with 1 representing the lowest
level of skills required, and 4 the
highest level. For example, the def-
inition of Grade 1, Respiratory
Demand (R), is: very little pressure
increase over regular breathing
required to produce sound or action
from toy; while Grade 4,
Respiratory Demand (R), is: consis-
tent deep breath and grading of air flow required
to change or produce sound or action (Oetter et
al, 1995, Ch 3, p5).
Using M.O.R.E., clinicians are able to:
assess oral (O) and respiratory (R) organisation
and coordination while a child is using a range oforal play materials (motor (M) and eye/hand (E)
coordination and control can also be assessed).
choose materials appropriate to a childs level of
oral and respiratory organisation and coordina-
tion.
plan intervention to facilitate sensory experi-
ences of increasing complexity and specificity to
the oral, pharyngeal, laryngeal and respiratory
areas.
directly shape the development of a childs suck,
swallow, breathe synchrony.
Intervention for suck swallow breathe asyn-
chrony does not require the subject to consciously
consider or monitor in isolation the initiation and
maintenance of breath support, voicing, articula-
tory movement and sound/word production. The
intervention programme aims to provide sensory
stimuli to the entire oral area, the pharynx, larynx
and the respiratory system and to replicate the
synergy characterising SSB synchrony. The provi-
sion of specifically tailored oral sensory input to
individual clients needs enables them to seek and
use more difficult oral sensory motor materials in
an adaptive manner. This is achieved as clients are
ready and able to do so and in a consistently moti-
vating, challenging and enriching context.
For an example of how an intervention pro-
gramme using the MORE approach and seeking to
facilitate SSB synchrony may look, see table 1.
The provision ofspecifically tailoredoral sensory input
to individual clientsneeds enables themto seek and usemore difficult oralsensory motormaterials in anadaptive manner.
Stage
1
2
3
4
Sensory experiences
Clients are provided with a range of sensory experiences through oral play.Opportunities to:a) initiate and maintain* blow and suck* oral motor and respiratory control.b) adapt responses to activity demand with more control and consistency.
Oral toys are now chosen for the
* level of SSB synchrony they can facilitate; for example, a flute versus a kazoo.* specific sensory experiences they can provide. For example, if a client has dif-ficulty grading blow (that is, moving from hard to soft blowing), then oral toysand sensory experiences which assist in this adaptation are made available.Toys for facilitating grading of blow may include a range of bubble blowers,
peashooters, blow-darts/pens, flip-flap balls.Appropriate support to achieve optimal functioning is also provided, such as
jaw support to encourage less bite and more lip closure/control on toys.
If the client is able to move from one adaptation to another, for example hardto soft to hard blowing, then it is time to move on to sensory experiences thatreinforce the ability toa) initiate and maintain* oral and respiratory organisation at the same level; for example, when askedto blow harder, the client can maintain oral control; when asked to change lipposture, the client is able to do this without losing respiratory control - forexample, lips behindthe mouthpiece of a trumpet versus lips overa trumpet.* oral and respiratory control across oral play materials, that is, not losing thelevel of control already achieved when moving from one toy onto another oraltoy, for example, from apenny whistle to a bubble blower.b) modify the grading of suck and blow according to specific demands.c) increase endurance and strength of suck, swallow and breathe.
Once SSB synchrony is achieved at most levels of demand and across a varietyof oral play materials - that is, it is an integrated, generalised skill - then it maybe appropriate to focus again on specific sensory experiences for the purposesof sound system development. For example, encouraging sucking and experi-mentation in the back of the mouth, to improve sensation to this area and toprepare the client for establishing placement for the velar plosives /k/ and /g/.
Outcome
* Observations reveal the level to which the client caninitiate and maintain control of oral and respiratoryfunction under differing circumstances. As a result,more specific input can now be planned.* Clients are highly motivated for a range of experi-ences with a wide range of oral play materials.
* Grading of oral and respiratory control may require
differing levels of support from the clinician.* A specific response may only be achieved followingsome attempts at achieving the target.* If the client has difficulty initiating a suck, differentmeans for eliciting a suck are attempted. The abilityto initiate a suck should be established by the end ofthis stage.* Clients become more confident and are more likelyto seek different sensory experiences spontaneously.
* The client is now able to grade with minimal sup-port from the clinician and usually as soon as a specif-ic response is requested.* For clients with difficulties initiating a suck, it maybe possible at this stage to move from drinking-basedsuck to other suck activities, for example sucking on astraw to move pieces of paper from one location toanother.* The following are increasing:==> Self-generated experimentation with oral playmaterials.==> Strength and endurance of oral and respiratorycontrol and coordination.==> Ability to modify oral and respiratory control tochanging demands with speed and accuracy.
The sensory experience of the feature/s of a sound -such as length (plosive vs fricative) - before thatsound is targeted, is likely to result in increased accu-racy and speed of target sound production. This maythen generalise to sound production in words and toother sounds with similar features.
Table 1: Stages of development in establishing and developing suck swallow breathe synchrony
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sensory integration
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 200010
Functional changeUsing this approach over a five year period, I have
found that, by developing SSB synchrony with
children with speech disorders (particularly motor
speech disorders such as developmental verbal
dyspraxia), more effective oral sensori-
motor planning and coordination has
resulted. Provision of appropriate and
high quality sensory experiences has
increased the clients ability to inte-
grate their sensory and motor respons-
es. The effect of the latter is to pro-
duce a marked refinement in oral
function both as a whole and for spe-
cific oral and speech movements.
Importantly, functional changes are
achieved without developing splinter
skills such as the ability to lick lips, and
in a setting where clients are not being asked to
produce oral motor or speech movements in isola-
tion (see case example).
Sensorimotor deficits potentially impact on oral
motor and sound system development and may
contribute to the continued presence of
speech/phonological impairments. The approach
presented in this paper may provide the basis for
the future development of assessments used with
speech disordered children. Certainly, interven-
tion strategies for speech disordered children pre-
senting with sensorimotor deficits can be
informed and challenged by the approach.
With many researchers agreeing that sensory
information or input is an integral part of move-
ment control and co-ordination (Van
der Merwe, 1997, p3), this approach
can potentially be used in the man-
agement of adult clients presenting
with speech motor difficulties, partic-
ularly where the sensory deficit is
clearly identified. The materials used
to facilitate SSB synchrony may differ
but the basic premise of utilising the
synchrony to elicit ever increasing
control and integration of oral motor
skills remains.
Future research into developmental
speech disorders should seek to
further investigate the relationship between
sensorimotor input deficits and motor/speech out-
put deficits.
provide diagnostic markers for the type and
level of sensorimotor breakdown in children pre-
senting with a range of speech disorders, particu-
larly motor speech disorders such as developmen-
tal verbal dyspraxia.
determine assessment techniques that more
directly measure sensorimotor skills of speech dis-
ordered children.
provide normative data regarding the develop-
ment of suck swallow breathe synchrony.
provide the evidence base to support the use of
sensory integrative assessment and intervention
strategies when managing developmental speech
disorders.
Olwen Pate is Principal Speech and Language
Therapist (Paediatrics) with Croydon and Surrey
Downs Community Health NHS Trust at
Sanderstead Clinic, 40 Rectory Park, Sanderstead,
CR2 9JN.
ReferencesAyres, A.J. (1979) Sensory Integration and the
Child. Western Psychological Services, USA.
Laurel, M. & Windeck, S. (1989) A Theoretical
Framework combining Speech-Language Therapy
with Sensory Integration Treatment. Sensory
Integration Special Interest Section Newsletter 12
(1) 1-5.
Oetter, P., Richter, E. & Frick, S. (1995) M.O.R.E.
Integrating the Mouth with Sensory and Postural
Functions. Hugo, MN: PDP Press, Inc.
Pate, O. & Pinkstone, M. (1996) Suck Swallow
Breathe Synchrony (SSB) and its Relationship to
Case example
Gary, 4.3 years, has a severe oral motor dyspraxia and phonological disorder. Hewas seen intensively for nine 30 minute sessions. Prior to intervention, his oraland respiratory organisation/control was limited and he was unable to suck.During intervention, once he had mastered oral play materials that requiredincreasing levels of oral and respiratory organisation and coordination for blow,he sought SSB activities that relied on the development of his suck. In the finaltherapy sessions he was able to suck drink up lengthy tubing (one to two metreslong) while standing up. The latter entailed him coordinating his breathing while
maintaining suck over periods of up to three to four minutes. Following interven-tion, oral motor assessment revealed there was an increase in Garys: postural, head and neck stability and control. jaw stability, allowing for isolation of oral movements. respiratory control and coordination. ability to initiate and sustain oral movements more effectively and to
coordinate oral movements with respiratory support.Assessment of Garys sound system revealed his phonetic inventory and phoneticdistribution had expanded. These expansions were integrated into Garys systemin both an idiosyncratic and appropriate fashion, as would be expected for asound system that continued to be disordered.
Examples of word initial position changesTarget Pre Post Target Pre PostHouse a Thumb m tmSun n n Saucer a saClown n n Sugar d daSock q Jam m mTeeth t Zip i ipChair a Mouth b mDress Girl d rl
Examples of word initial cluster developmentsSmoke ma ma Three wSnake nei snei Sleeping pi eipinSwimming imim imin Spoon un punBridge bid bwid Sweeties wiFlower wa aw Sky dai taiBlue bju blu Green n qwn
Examples of other changesMoney mn mn Baby bb beibPushing p phin Watch mw wtDoll da dl Fork u
this approach
can potentiallybe used in themanagement of
adult clients
presenting withspeech motordifficulties
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sensory integration
Oral Sensory
Motor Control
and Speech
P r o d u c t i o n
Skills. Proceedings of the First International SI-
NDT Congress, Cape Town, South Africa.
Pinkstone, M. (1995) Suck Swallow Breathe
Synchrony: A single case study investigating the
relationship between oral sensory-motor control
and speech production in a dyspraxic child.
Unpublished project.
Selley, W., Ellis, R., Flack, F. & Brooks, W. (1990)
Coordination of sucking, swallowing and breath-
ing in the newborn: Its relationship to infant
feeding and normal development. British Journal
of Disorders of Communication 25 (1) 311 - 327.
Smith, A., Goffman, L. & Stark, R.E. (1995) Speech
Motor Development. Seminars in Speech and
Language 16 (2) 87 - 99.
Van der Merwe, A. (1997) A Theoretical
Framework for the Characterisation of
Pathological Speech Sensorimotor Control. In
McNeil, M.R. (Ed) (1997) Clinical Management of
Sensorimotor Speech Disorders. Theime, New
York.
Wolf, L.S. & Glass, R. P. (1992) Feeding and Swallowing
Disorders in Infancy, Assessment and Management.
Tucson, AZ: Therapy Skill Builders.
eflections
Do I give sufficient
onsideration to
he benefits of
nput as well as
utput therapy for
lients with oral /
peech motor
eficits?
Do I have the
ange of equipment
ecessary for
lients to develop
ral motor skills?
Do I explore the
otential of
heoreticalpproaches
mbraced by
elated professions?
Do your clients want more speech work than your time allows? Carol Bishops clients did, so she
developed Speech Sounds on Cue. This CD ROM provides multimedia cues for 531 consonant/
vowel and consonant/vowel/consonant words covering 19 consonant sounds in initial position.
Carol, senior speech pathologist at the Aged Care Rehabilitation Unit in Hobart, Tasmania,
designed the software for adults with dyspraxia, but it may also be suitable for children with dys-
praxia or Autistic Spectrum Disorder and people with a hearing impairment.
Speech & Language Therapy in Practice has a copy of Speech Sounds on Cue to give away FREE
to a lucky subscriber, courtesy of its UK distributor, Propeller Multimedia Ltd. It normally costs 90
+ 5 delivery + VAT for single copies.
To enter, simply send your name and subscriber number / address marked Speech Sounds on
Cue to Avril Nicoll, 33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail avrilni-
[email protected] by 14th October, 2000. The winner will be drawn randomly from all valid
entries.
*The program is operated using a mouse, touchscreen or simple keyboard control.Recommended specifications: IBM PC running Windows 95 and above. Pentium 200 Mhz with 32
MB RAM, 24 bit true colour, 16 bit sound card and speakers and 16 speed CD-ROM drive.
Will also run on Apple Macintosh G3, 32 MB RAM, System 8 or later, 16 speed CD-ROM.
Speech Sounds on Cue is available from Gordon Russell, Propeller Multimedia Ltd. P.O.
Box 27028, Edinburgh, EH10 6WD, Scotland, tel/fax. 0131 446 0820,
www.propeller.net/react
Do you want a comprehensive measure of language skills for
clients in the age group 6-21 years? The Clinical Evaluation of
Language Fundamentals (CELF) has now been adapted and stan-
dardised for use in the UK, and Speech & Language Therapy in
Practice has a copy to give away FREE to a lucky subscriber, cour-tesy of The Psychological Corporation. It normally costs 345.20.
To enter, simply send your name and subscriber number / address marked CELF to Avril Nicoll,
33 Kinnear Square, Laurencekirk AB30 1UL, tel. 01561 377415, e-mail [email protected]
by 14th October, 2000. The winner will be drawn randomly from all valid entries.
CELF-3UK
is available from The Psychological Corporation, FREEPOST WD147, HarcourtPlace, 32 Jamestown Road, London NW1 1YA, tel. 020 7424 4456.
1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy inPractice, and only one entry per subscriber number is allowed.
2. Entries must be received by the editor on or before 14th October, 2000.3. The winner will be randomly selected from all valid entries.4. The winner will be notified by 21st October, 2000.5. The winner will have access at work to suitable computer hardware.*6. The winner will review Speech Sounds on Cue for Speech & Language Therapy in Practice by a date
agreed with the editor.
1. Entrants must subscribe personally or as one of a department to Speech & Language Therapy inPractice, and only one entry per subscriber number is allowed.
2. Entrants must be registered speech and language therapists.3. Entries must be received by the editor on or before 14th October, 2000.4. The winner will be randomly selected from all valid entries.5. The winner will be notified by 21st October, 2000.6. The winner will review the CELF-3UKfor Speech & Language Therapy in Practice by a date
agreed with the editor.
Win Speech Sounds on Cue
Win CELF3UK
Congratulations to Carol-Anne Murphy who
won Clicker 4, and to Mrs L. Collier, Debbie Rai, Margaret Rooney and Hilary Jarvie who
won photocopiable resources from Black Sheep Press in the Spring 00 issue of Speech &
Language Therapy in Practice.
Previous winners...
..READ
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COMPETITIONRULES:
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picturesposedbymodels
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7/28/2019 Speech & Language Therapy in Practice, Autumn 2000
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Colorcard resourcesEDUCATION
All from Winslow
Pocket Colorcards
Early Objects, Early Actions, Early Sequences, Early
Opposites
19.95 for fourThe best thing about these is their size as the playing-card
sized photographs fit inside fishing games and post-boxes
with ease! They have been produced especially for chil-
dren so the objects, actions, concepts (pairs of pictures
such as big/little) and sequences (three-part, for example
having a haircut) are all appropriate to this client group.
These are excellent value and a must for anyone working
with preschool or primary-aged children.
Whats Inside?
24.95This set contains pairs of cards, one of which shows the out-
side of a container (such as a fridge, school bag, first-aid
kit) and the other its contents. Children enjoy using this
resource to work on vocabulary, categorisation, prediction
and descriptive skills and it will be most useful to therapists
working in mainstream and special school settings.
What Is It?
28.75These are object photographs with two smaller pictures
that show parts of the object (a computer has smaller pic-
tures of the keys and the mouse) or the object from an
unusual viewpoint (a wellington boot is viewed frombelow and behind). This provides effective but limited
ways to work on vocabulary, descriptive skills and spatial
concepts with school-aged children.
Sequencing Sounds
35.50
This activity involves matching sequences of sounds (sup-
plied on cassette tape) to pictures. The two and three-
sound sequences include eating crisps and scrunching up
the packet and playing a drum, xylophone and maracas.
Although useful for working on listening skills there are
limited ways in which this material could be presented.
Using Colorcards in the classroomISBN 0 86388 188 2 9.95 This book provides a practical collection of ideas for using
Colorcards (or similar resources) to develop listening and
attention, comprehension, vocabulary, expression,
sequencing, and social skills. The aim of each activity is
clearly stated along with suggestions for varying the level
of difficulty. The index allows you to select activities to
link in with the National Curriculum (Key Stage 1 and 2).
This book is most useful as a resource for teachers and
assistants working in mainstream or special schools but is
also worth a glance by speech and language therapists
looking for some new ideas.
Diane Stanger is a speech and language therapist with
Sussex Weald & Down NHS Trust.
Essential reading
Parkinsons Disease - Studies in
Psychological and Social Care
Ed. Ray Percival and Peter Hobson
The British Psychological Society, tel. 0116
254 9568
ISBN 1 85433 299 6 12.95
This interesting and readable book opens with an
excellent introduction to the nature and courseof Parkinsons Disease. The following chapters
represent a sample of recent research into the
needs of people with Parkinsons and those of
their carers and families.
The second half covers assessments and inter-
ventions including psychological groups, support
networks, communication, swallowing, and a
useful chapter on driving.
This book describes in detail the full impact of
Parkinsons Disease on peoples lives. It should be
essential reading for anyone who provides, or is plan-
ning to provide, a service to people with the disease.
Sue Chorlton is a speech and language therapist
at Weston General Hospital, North Somerset.
reviews
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 200012
A revelation
Have I Got Views For You!Joan Murphy
University of Stirling, tel. 01786 467645,
e-mail [email protected]
ISBN 1 85769 0990 25
For people with Motor Neurone Disease whose
ability to communicate is limited, this framework
to enable them to discuss their quality of life is a
revelation. As such it is very relevant to the
speech and language therapists work. The
instructions for its presentation to the MND suf-
ferer are clear. The delightful materials do not
take an inordinate amount of time to prepare.
As a retired speech and language therapist who
now works as a Volunteer Visitor for the Motor
Neurone Disease Association, my role is about
quality of life issues in particular. Thus I found
this easy to administer framework an excellent
way of helping sufferers reveal needs which
could not have surfaced in any other way.
A future edition could include details of the
Motor Neurone Disease Association as well as the
Scottish Motor Neurone Disease Association, as it
provides services and information for people liv-
ing in the rest of the UK.
I consider this package value for money and rec-
ommend it thoroughly.
Adrianne Marks is a retired speech and language
therapist, formerly at St Marys Hospital, London and
the Domiciliary Service of Parkside Health Authority.
REVIEWS. . . . . . . . . . . . . .r e v i e w s
Help me Talk Right
How to Correct a Childs
Lisp in 15 Easy Lessons
(0-9635426-0-5)
How to Teach a Child to Say
the R Sound in 15 Easy
Lessons (0-9635426-1-3)
How to Teach a Child to Say
the L Sound in 15 Easy
Lessons (0-9635426-4-8)
Mirla G. Raz.
Gersten Weitz Publishers, tel.(480) 951 9707,
www.speechbooks.com /www.thinkingpublications.com
$32+shipping (each)
These three books are designed
so non-professionals can use them
under a therapists supervision. It
is not dynamic therapy - and the
sixteen small black-and-white pic-
tures per page are not inspiring -
but they are easy to follow with
useful trouble shooting sections.
They progress logically from
teaching tongue positions, to pro-duction of each sound in isola-
tion, in different positions in sylla-
bles and words, then in sentences
and consonant blends and finally
carry-over into conversation.
However, placing the tongue
behind the bottom teeth for /s/ is
controversial and the emphasis on
motivating through monetary
gain questionable.
Another limitation is the
American vocabulary with which
most English children will be
unfamiliar. Most therapists
already have a wide range ofmaterials for these sounds. Given
budget limitations and the high
number of serious communication
disorders on most caseloads, I
would not recommend these
books for UK therapists.
Nevertheless it is useful to have a
relatively tailor-made package for
minor speech problems and they
are reasonably priced.
Janet Farrugia runs an indepen-
dent speech and language thera-
py practice in Bookham, Surrey.
Easy to follow,but not dynamic
ARTICULATION
PROGRESSIVE NEUROLOGICAL
PROGRESSIVE NEUROLOGICAL
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Easy to read and use
Cognitive Neuropsychology and
Conversation Analysis in Aphasia. An
Introductory Casebook.
R. Lesser and L. Perkins
WhurrISBN 1 86156 068 0 24.50
This practically-based workbook does not dwellon theory and is easy to read and use. The aim is
to demonstrate how the integration of
Cognitive Neuropsychology and Conversation
Analysis can provide rationally motivated apha-
sia therapy. A basic working knowledge of the
approaches is assumed although brief overviews
of both are given.
The authors present six real case studies and
ask the reader to suggest initial hypotheses,
assessments, interpretation of results and
approaches to therapy. Photocopiable work-
sheets are provided. At each stage, the reader
can compare their ideas to those presented by
the authors. Answers are therefore providedbut the authors clearly expect and encourage
variations.
This book is a valuable and reasonably-priced
resource for aphasia therapists aiming for a
structured balance between impairment-
focused therapy and a more functional interac-
tion-based approach. It is designed to provide a
constant source of reference and would benefit
experienced practitioners, newly-qualified ther-
apists and students on placement.
Kit Barber is a specialist speech and language
therapist working with community-based adults
for North East Wales NHS Trust.
ADULT NEUROLOGY
Enthusiastic and personal
Reasons and Remedies
Patricia SimsMortimore Books, PO Box 156, Barnstaple,
EX33 1YN
ISBN 0-9536209-0-5
12.95 (10.95 if ordered directly)
Speech, language, learning and social prob-
lems, such as stammering, dyslexia and autism,
need no longer be puzzling. If we enquire in
some depth into the personality traits of young
children, we will discover mechanisms which lie
behind such problems.
In her long career with special needs children,
Patricia Sims has developed her holistic method
of working which she says has increased success
of therapy as well as her own job satisfaction.
The book includes a very comprehensive,
detailed checklist for case history taking and many
vignettes from cases to illustrate her theories.
A very enthusiastic and personal book. Easy to
read, it should stimulate creative thought, how-
ever experienced the reader.
Rosemary Fisher specialises in dysfluency in
adults and children. She works in Derby.
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 2000 13
reviews
Raises awareness
Fragile X Syndrome - An Introduction
Fragile X Society, tel. 01424 813147
Video+booklet 5.00This twenty minute video aims to help profes-
sionals know when to suspect Fragile X may be
present, understand its effects, and initiate early
multidisciplinary evaluation, intervention and
support.
Interviews with professionals and parents,
together with film of those affected, demon-
strate and explain the characteristics effectively.
The accompanying booklet explains more about
speech and language than does the video. The
many benefits and implications of diagnosis are
discussed, and there is a positive emphasis
throughout.
A useful and good value resource to share with
colleagues, and to raise our own awareness of
the condition, the characteristics of which have
management implications.
Fiona Ashford is a speech and language thera-
pist working in the Special Needs Team in
Portsmouth Healthcare NHS Trust.
Enjoyable, with excellentillustrations
More Than Words (Helping Parents
Promote Communication and Social Skills
in Children with Autistic Spectrum
Disorder)
Fern Sussman
The Hanen Centre; available from WinslowISBN 0-921145-14-4 26.95 + p&p
This is a valuable resource book for any therapist
who has contact with children with autistic spec-
trum disorder.
Following a similar format to the original
Hanen It Takes Two To Talk, it establishes the dif-
ferent stages of communication and essentials
for good communication (OWLing - observing,
waiting, listening - and additional new
acronyms) and then moves on to useful exam-
ples of how to develop play and share books or
music.
In addition, it addresses specific aspects associ-
ated with autistic spectrum disorder, such asexplaining sensory-motor preferences and the
way the children acquire information. Especially
useful are the examples of adapting language
and using augmentative communication.
A well-priced, easy and enjoyable read with
excellent illustrations, it has well structured
examples of functional ideas for parents to try.
Fiona Coughlan works for Warrington
Community Health NHS Trust with preschool and
primary school children with special needs.
AUTISTIC SPECTRUM
Informative and inspiring
Fluency courses at the Apple House,
Oxford, 1966 - 1998 - An Evaluation
Dr Rosemary Sage
The Stammer Trust
ISBN 0 9534807 0 4 7 inc. p&pThis clear, readable account of thirty years of
evolving stammering therapy at Apple House
begins with a succinct history of stammering and
goes on to give brief summaries of recent
research. Results of different approaches to ther-
apy are included and discussed.
The second half concerns itself with the numer-
ous aspects of running the courses at Apple
House. Four case histories are included with a
summary and evaluation of the therapy program.
This report combined the scientific with the
therapeutic in an informative and inspiring for-
mat. The richness of the therapists and clients
experiences was quite enviable. This report is
excellent value for money and I recommend it to
students and therapists alike.
Amanda Mozley is head speech and language ther-
apist at Chelsea and Westminster Hospital, London.
Invaluable software
Boardmaker
Mayer-Johnson plc
250 plus VAT
Available for Apple Macintosh or Windows
Version evaluated: Boardmaker for WindowsThis computer programme, containing over 3000
picture communication symbols, allows you tomake attractive communication boards and dis-
plays suitable for use with children and adults. It
comes with a clearly written users guide and an
excellent 60 minute instructional video.
With the programme you arrange cells - boxes
in which you place picture symbols - anywhere
on a page; make them different sizes; change
their border colours - useful if you want to say
colour code nouns and verbs; display text with
your symbol in up to two languages -
Boardmaker comes with ten; plus you can add
your own text and other language fonts. You
can also make your own symbols or bring pho-
tographs into the programme.As with any programme there were one or two
initial headaches in using it, and some of the sym-
bols arent quite appropriate for the UK; for exam-
ple the word goal produces a picture symbol quite
unlike any set of goal posts Ive seen in this country.
Verdict: an easy to use and invaluable piece of
software which produces attractive materials.
Neil Thompson is a speech and language thera-
pist in mainstream schools and schools resourced
for children with medical needs/physical disabili-
ties. He works for Newham Community Health
Services NHS Trust, East London. He won
Boardmaker in the Winter 99 reader offer of
Speech & Language Therapy in Practice.
DYSFLUENCY
LANGUAGE DEVELOPMENT
CHILD DEVELOPMENTSYNDROMES
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or the past six years the Department of
Human Communication Science atUniversity College London (UCL) has been
developing an approach to speech and
language therapy students professional and clin-
ical learning which emphasises active participa-
tion from the earliest stages of clinical placements
(Morris, 1998; Parker & Kersner, 1998). We have
been moving towards emphasising reflective
cycles of learning which integrate practice, theory
and rehearsal, rather than the traditional linear
model with its expectation that theory and obser-
vation should always precede practice (Schon,
1983, 1987; Kolb, 1984; Stengelhofen, 1993;
Morris & Parker, 1998). Speech and language ther-
apy students reported experience of learning
more effectively through active participation is
supported by Erauts work on the relationship of
practice with theory in professional learning (for
example Eraut, 1994). Real responsibility helps the
development of confidence and allows students
to gain a deeper understanding of related theory
(Kersner & Parker, 1999).
One application of this approach has involved a
partnership with the Stroke Association Dysphasia
Support Service in London. The placement was
first set up in 1997, and is completed by under-
graduate Speech Sciences students as a prepara-
tion for their main final year placement with
speech and language therapy services for clients
with acquired disorders of speech, language and
cover story
SPEECH & LANGUAGE THERAPY IN PRACTICE AUTUMN 200014
Read this if you:want innovative
ideas for trainingbelieve student
training shouldalso benefitclients
are interested inworking with thevoluntary sector
Research shows individuals learn more
effectively when given responsibility and
encouraged to participate actively. Suzanne
Beeke andAnn Parkerare behind an innovative
programme where speech and languagetherapy students become temporary volunteers
for the Stroke Association. Here, they explain
how this has benefited the people living with
dysphasia as much as the students.
Fvoice. The design and organisation of the place-
ment has just been revised in the light of an auditcarried out in the summer of 1999.
Students are assigned, in pairs, to work with one
of the London Stroke Associations Dysphasia
Support groups, which are affiliated with the
Stroke Association Dysphasia Support Service. The
dysphasia support organiser acts as their supervi-
sor for the duration of the four week placement.
Non-local speech and language therapy supervi-
sion is provided by a member of the clinical staff
at UCL.
Support and practiceEach pair of students assists the dysphasia support
organiser in planning and running the weekly
stroke group, and also makes visits to certain
group members who have requested that a
Stroke Association volunteer visit them at home.
Each pair of students visits two people twice a
week for approximately one to one and a half
hours per visit. During this time students work as
Stroke Association volunteers, fulfilling the objec-
tives of the Dysphasia Support Service by provid-
ing support with, and practice of, communication
for the stroke person in their own home (The
Stroke Association, 1999). Verbal and written
information which clearly states that students are
not qualified or expected to provide speech and
language therapy is given to the dysphasic indi-
viduals, their family members, the dysphasia sup-
port organiser and the students before the place-
ment begins. The programme specifies that stu-dents must only visit individuals who are not
being treated by a speech and language therapist
during the time when visits will take place.
The placement aims for students to:
1.develop the ability to interact with adult
clients
2. experience working as a volunteer within a
community-based service for clients with
dysphasia
3.be aware of the psychosocial and practical
aspects of life for people with dysphasia, and
for their families
4.develop a problem-solving approach to
clinical work5.continue to develop independent learning
skills
6. enhance the ability to seek and act on
feedback on performance from a range of
sources, including the client, family members
and professional colleagues
7.enhance the ability to take responsibility for
day-to-day organisation of home visits,
session planning, administration tasks and
report writing
8.continue to develop pair-work skil